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PubMed2003

Effect of an oral contraceptive containing drospirenone and ethinylestradiol on general well-being and fluid-related symptoms.

Oral contraception is the most widely used reversible contraceptive method. Continuous research over the past decades has led to a range of highly reliable, effective and safe oral contraceptives. Newly developed progestogens may also provide additional non-contraceptive health-related benefits that differentiate the products from each other. Women desiring contraception may thus choose from a wide range of oral contraceptives according to their individual needs. A variety of physical and emotional changes have been linked to hormonal fluctuations during the menstrual cycle. To date, only very few studies have been performed on the impact of fluid retention-related symptoms on well-being and few data are hence available on suggested methods of measurement. This open, multicenter, uncontrolled study evaluated the effects of a combined preparation containing 3 mg drospirenone and 30 microg ethinylestradiol (Yasmin, Schering AG, Berlin, Germany) on general well-being and fluid-related symptoms in women experiencing psychological, behavioral and somatic premenstrual symptoms. The study was conducted over six 28-day cycles, with 336 subjects enrolled. A significant beneficial effect on psychological general well-being, as measured by the Psychological General Well-Being Index (PGWBI), was evident by cycle 3 and maintained at cycle 6. There was a significant reduction in both the incidence and severity of somatic symptoms associated with the menstrual cycle (abdominal bloating and breast tension) during treatment. Assessment by the investigator showed that 80% of subjects had improved on study treatment and 75% of subjects considered themselves satisfied with the study treatment. There was good agreement between the clinician and subject in their assessment of the treatment. Cycle control was very good and body weight remained stable or decreased slightly during the study. In conclusion, 3 mg drospirenone in combination with 30 microg ethinylestradiol has been shown to have a beneficial effect on psychological general well-being, as measured by the PGWBI. Reductions in the incidence and severity of somatic symptoms associated with the menstrual cycle were also observed, suggesting a beneficial effect due to the antimineralocorticoid nature of drospirenone. To our knowledge, this is the first study on oral contraceptives which has used the PGWBI in this population. As quality of life is one of the least explored segments in oral contraceptive users, more studies should investigate the impact of oral contraceptives on quality of life and general well-being in this overall healthy population.

Adolescent↗
PubMed2005

Psychological status and depression in patients with liver cirrhosis.

BACKGROUND: Previous studies reported an impairment of both the physical and mental dimensions of quality of life in patients with cirrhosis. Very few data are available on the psychological impact of the disease and its relation to liver function. AIM: To measure the psychological status of patients with cirrhosis in relation to the severity of the liver impairment. PATIENTS AND METHODS: One hundred and fifty-six patients with cirrhosis were studied. Two questionnaires (the Beck Depression Inventory and the Psychological General Well-Being Index) were self-administered in random order. Clinical and laboratory data were collected using standardised forms. RESULTS: The global score of Psychological General Well-Being Index was severely reduced compared to Italian population norm. Among individual domains, the more severely affected was General Health, the less compromised was Positive Well-Being. A negative relation was found between Child-Pugh score (a comprehensive measure of disease severity) and global Psychological General Well-Being Index and several individual subscales. The Beck Depression Inventory scores were indicative of a depressed mood in over 50% of patients, in relation to the presence of clinical symptoms. CONCLUSIONS: Patients with cirrhosis have signs of psychological distress and depression, as assessed by Beck Depression Inventory and Psychological General Well-Being Index, in relation to the severity of liver disease. Accordingly, a non-negligible number of patients warrant treatment.

Adult↗
PubMed1997

Measuring general practitioner psychology: the personal construct perspective.

BACKGROUND: According to personal construct theory (PCT), psychological processes are determined by the way in which individuals perceive differences and similarities between aspects of their environment and by the way this information is used to assist in the prediction of events. The important discriminations made by individuals are called "constructs'. OBJECTIVE: This article seeks to introduce PCT as a psychological measurement procedure to complement traditional standardized scales in research in general practice. METHOD: The repertory grid technique is a method of eliciting the content of the individual's constructs and determining their structure and inter-relationships. PCT and traditional measurement procedures are compared and contrasted, and the relevance of PCT to general practice psychology is discussed.

Attitude of Health Personnel↗
PubMed2002

Effects of electro-acupuncture on psychological distress in postmenopausal women.

OBJECTIVES: To evaluate effects of electro-acupuncture (EA) on general psychological distress and relate to experience of climacteric symptoms in 30 postmenopausal women. DESIGN: A randomised single-blind controlled design was used to evaluate effects of EA and extremely superficial needle insertion, with the latter serving as a near-placebo control. SETTINGS: The Linköping University Hospital in Sweden. INTERVENTIONS: Fourteen treatments during 12 weeks with follow-ups at 3 and 6 months. OUTCOME MEASURES: General psychological well-being, mood and experience of climacteric symptoms. RESULTS: Mood Scale improved only in EA group and not until 12 weeks compared to baseline, from 110 to 129 (P = 0.01), and to 120 at 3-month follow-up (P = 0.04). Mood was significantly better than control at 8 (P = 0.05) and 12 weeks (P = 0.01). Visual analogue scale estimation of climacteric symptoms was decreased at 4 weeks in both groups, and lasted throughout the study period, in EA group from 5 to 2 (P = 0.04) and in control group from 5 to 3 (P = 0.02) at 6-month follow-up. Well-being was ameliorated from 4 weeks in EA and from 8 weeks in control group until end of study (P = 0.01, P = 0.03). No significant differences on climacteric symptoms or well-being existed between the groups. CONCLUSIONS: This study does not show that EA is better than superficial needle insertion for the amelioration of general psychological distress and experience of climacteric symptoms in women with vasomotor symptoms after menopause. However, the more pronounced effect on mood suggests that EA might have additional effects compared with superficial needle insertion.

Acupuncture Therapy↗
PubMed2006

Gastroesophageal reflux symptoms and well-being in a random sample of the general population of a Swedish community.

OBJECTIVES: There is limited information on the relationship between gastroesophageal reflux symptoms and well-being in the general population. This study aimed to investigate this relationship and determine the severity threshold at which reflux symptoms meaningfully affect patients' well-being. METHODS: A random sample of the population of Malmö, Sweden (n = 4,624), was sent the Gastrointestinal Symptom Rating Scale, the Subjective Symptom Assessment Profile, and the Psychological General Well-Being Index. The relationship between well-being and the severity of heartburn, acid regurgitation, stomach pain, and abdominal pain was investigated by analysis of covariance (ANCOVA). RESULTS: Complete data were obtained from 1,476 subjects (43% male; mean age [standard deviation], 49.9 [14.2] yr). The mean Psychological General Well-Being Index score was 102 (95% CI: 101-103). Increasing symptom severity was associated with a decrease in well-being, and correlations between Psychological General Well-Being Index score and symptom severity ratings were statistically significant. At least mild symptoms of heartburn or abdominal pain (a mean Gastrointestinal Symptom Rating Scale score of > or =3) were associated with a clinically meaningful reduction in well-being (a Psychological General Well-Being Index score of less than 98). CONCLUSIONS: Reflux symptoms are associated with impaired well-being in the general population. Individuals with symptoms that are mild or more severe report a meaningful reduction in well-being similar to that seen in other diseases. This may represent an appropriate threshold for patient selection in trials of GERD therapy and for more detailed evaluation of patients consulting with reflux symptoms in clinical practice.

Adaptation, Physiological↗
PubMed2000

General practitioner psychological management of common emotional problems (II): A research agenda for the development of evidence-based practice.

The majority of patients with common emotional or psychological problems are treated solely by general practitioners (GPs). Such treatment frequently includes some form of psychological management within the consultation, whether limited to listening and discussion or involving more specific techniques. This paper sets out a research agenda for the development of effective approaches to GP psychological management. Evidence is reviewed on three core components of all psychological treatments: establishing a positive therapeutic relationship, developing a shared understanding of the problem, and promoting change in behaviour, thoughts or emotions. The application of these components in GP psychological management is outlined and methodological issues in the development and evaluation of GP management approaches are discussed. Since the number of patients with emotional problems seen by each GP is so large, the population effects of even small improvements in psychological management would be sizeable.

Affective Symptoms↗
PubMed2000

General practitioner psychological management of common emotional problems (I): Definitions and literature review.

General practitioners' (GPs') treatment of patients with common emotional problems often includes some form of psychological management within the consultation. Such psychological management may be limited to listening and discussion or may also include more specific psychological approaches, such as use of counselling, problem-solving, or cognitive-behavioural techniques. This paper defines GP psychological management and reviews what is known about its frequency and effectiveness. MEDLINE and PsychLIT searches were undertaken of empirical studies of the psychological management of emotional problems by GPs in routine consultations published up to 1998. Thirty-six studies were identified. Most lacked details of the nature of the psychological management reported, making it difficult to compare studies. The frequency of use of psychological management by GPs was found to be generally less when rated by external observers than when assessed by GP self-report. There is preliminary evidence from a few studies of the clinical effectiveness of GP psychological management in routine consultations.

Affective Symptoms↗
PubMed2006

Comparison between subjective and objective assessment of the long-term results after the Heller-Dor operation in patients affected by oesophageal achalasia.

INTRODUCTION: Nowadays the subjective assessment of Health-Related Quality of Life after surgery for achalasia is often associated with the instrumental methods in order to evaluate long-term results of therapy. AIMS: To assess the long-term objective and subjective results of the surgical treatment of achalasia and to study the correlation between clinical-instrumental methods and those based on the patient's self-assessment and on Health-Related Quality of Life questionnaires. METHODS: One hundred and twenty-four patients consecutively submitted to trans-abdominal Heller-Dor operation were periodically followed up with clinical examination, endoscopy, barium swallow and manometry. The Health-Related Quality of Life was assessed using the 36 item short form (SF-36) and the Psychological General Well-Being Index questionnaire. The statistical comparison between the results of the self-assessment questionnaires and the long-term clinical-instrumental result was calculated by means of linear regression analysis. RESULTS: Over the years, 123 patients underwent at least one complete clinical-instrumental check-up and filled the self-assessment questionnaires. Mean follow-up was 105 months (range 12-288) with a median of 82.5 months. The result of the surgery was considered satisfactory in 93.5% of the patients, while the reflux oesophagitis observed in 6.5% of the cases was the main cause of failure. Clinical scores for dysphagia and for gastro-oesophageal reflux symptoms were significantly reduced after surgery. The results of the SF-36 and Psychological General Well-Being Index questionnaires were in our population very high and clinical correlation (p<0.05) emerged in physical function, in role physical, in mental health and in vitality domains of SF-36 questionnaire, and in self-control and general health scales of Psychological General Well-Being Index questionnaire. CONCLUSIONS: Health-Related Quality of Life questionnaires can be considered valid aids in evaluating surgical results, but the clinical-instrumental evaluation remains the cardinal point of every long-term assessment in order to diagnose complications, the disease-related conditions of the patient and to acquire reliable data on which scientific discussion can be based.

Deglutition Disorders↗
PubMed1998

Nonattendance at a general hospital psychological clinic in South Africa.

Over a 10-yr. period 11.6% of the 3738 patients referred to a general hospital's psychological clinic in South Africa did not attend their first appointments. Patients who had engaged in suicidal behaviours and those with somatoform symptoms were the predominant nonattenders, while those with depressive symptoms had the lowest nonattendance rate.

Adult↗
PubMed1982

Clinical psychology in general practice: a controlled trial evaluation.

A controlled trial study is described in which 50 consecutive potential referrals for psychological treatment from one general practice were randomly allocated either to behavioural treatment or no-treatment conditions. Treatment-group patients received treatment from a clinical psychologist working within the practice; the control-group patients continued to be managed by their general practitioner. The patients' use of NHS resources was assessed during the treatment period (or its equivalent for the control group) and at a follow-up comparison point, when the patients' subjective ratings of their progress were also obtained. Between referral and the end of treatment the treated group received significantly less psychotropic medication than the control group. This difference was not, however, maintained at the longer-term follow-up. No differences in general practice consultation rates, in the subjective ratings of psychological distress, in control orientation or life satisfaction were found between the two groups, but the level of patient satisfaction was high. Implications for the design of future studies and for psychological health care delivery systems are discussed.

Adult↗
PubMed2003

The adjustment to diabetes of school-age children with psychological adjustment problems.

OBJECTIVE: To determine whether diabetic children with psychological adjustment problems have greater difficulties in specific areas of disease adaptation than their well-adjusted diabetic peers by comparing their diabetes-related adjustments in the family, school and peer environments. METHOD: Mothers of 47 school-age preadolescent children with diabetes completed a standardized assessment of general psychological functioning. Children with psychological adjustment problems were then compared with children who did not exhibit problems along the following dimensions: their demographic and medical profiles, maternal diabetes knowledge, associations between general psychological functioning and diabetes control, and the quality of their diabetes adjustment. RESULTS: No differences were found between children with psychological adjustment problems and their better-adjusted peers along any of the demographic or health status variables tested or in maternal diabetes knowledge. However, children with adjustment problems were more likely to receive visits from the hospital's home-care team and to be absent from school. Also, for children with psychological difficulty, indices of diabetes control and general psychological functioning were related, and the nature of this relation differed across the school and family environments. In addition, poorer psychological adjustment was associated with diabetes-specific problems in both mother and child. These included individual adjustment problems such as feeling different, relationship difficulties with family and peers, and difficulties with the treatment protocol, in particular, with the dietary regime. CONCLUSION: These findings are considered in relation to (1). the importance of multi-method techniques in research which concerns adjustment to diabetes, in particular the need to use both psychological and disease-specific instruments, and (2). clinical evaluations and interventions for children with diabetes and their families.

Adaptation, Psychological↗
PubMed2001

A prospective investigation of quality of life and psychological well-being after the discontinuation of GH treatment in adolescent patients who had GH deficiency during childhood.

Some patients given growth-promoting therapy for GH deficiency in childhood will remain GH deficient in their adult lives and hence could benefit from continued GH replacement therapy. This longitudinal study sought to assess whether quality of life declines after GH discontinuation in late adolescence, and whether differences can be discerned in quality of life in patients whose GH deficiency persists into adulthood and those whose GH secretory capacity falls within normal ranges. Forty patients, aged 16-21 yr at baseline, were assessed over a 2-yr period commencing with discontinuation of GH therapy. Twenty-one patients were assigned to a GH deficiency group, and 19 were assigned to a GH-sufficient group. Quality of life assessments were made using the Nottingham Health Profile, Psychological General Well-Being Index, and Mood Adjective Check List Measures. Visual analog assessment of personality and affect and cognitive function tests were performed. The Mood Adjective Check List and visual analog assessments identified between-group and temporal changes in a limited number of the various personality domains assessed. The Psychological General Well-Being Index assessment indicated greater baseline impairment in the GH deficiency group than in the GH-sufficient group in overall score and in the domains of depression and general health. There was also a between-group difference in anxiety score at the 2-yr assessment, with the GH deficiency group having greater anxiety. Measurement of cognitive factors failed to reveal differences between groups. These results indicate that the discontinuation of GH therapy in late adolescence does not risk an immediate decline in the perceived quality of life detectable with the Nottingham Health Profile and Psychological General Well-Being Index measures. However, differences detected with the Mood Adjective Check List and visual analog assessments hint at clinically significant changes in the life experiences of adolescents discontinued from GH for which traditional measures may lack sensitivity.

Adolescent↗
PubMed1997

Impact of coronary artery bypass grafting on various aspects of quality of life.

OBJECTIVE: To prospectively study the improvement in quality of life (QoL) after coronary artery bypass surgery (CABG). PATIENTS AND METHODS: Consecutive patients (n = 2121) who underwent CABG at Sahlgrenska University Hospital between 1988 and 1991 received 3 questionnaires for the study of QoL: the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-being Index, which were responded both before surgery and at 3 months (n = 1059), 1 year (n = 1045) and 2 years (n = 1027) postoperatively. RESULTS: All differences were tested against baseline. The Physical Activity Score improved (mean 4.3 before CABG, 3.1, 3 months after (P < 0.0001), and 2.8, 2 years postoperatively (P < 0.0001)). The Nottingham Health Profile score improved (mean 20.5 before CABG, 11.4, 3 months (P < 0.0001), and 10.4, 2 years postoperatively (P < 0.0001)). The Psychological General Well-being Index improved (mean 91.1 before CABG, 103.8, 3 months (P < 0.0001), and 105.8 (P < 0.0001), 2 years after CABG). The subscale analyses of the Nottingham Health Profile and the Psychological General Well-being Index 2 years after CABG showed the greatest improvement in areas reflecting physical capacity and pain, to be followed by mental qualities. At 2 years after CABG only sexual problems were still markedly frequent, and independent predictors for sexual problems after surgery were preoperative problems (P < 0.00001), male sex (P < 0.0001), and diabetes mellitus (P = 0.0008). CONCLUSION: QoL was markedly and significantly improved after CABG. The major improvement was seen already at 3 months, with further slight improvement observed 2 years after surgery. The major improvement was found in areas reflecting physical capacity and pain, which is consistent with symptomatic and objective measurements after CABG. In contrast to the overall improvement in QoL sexual problems were still markedly common 2 years after CABG. The mechanism for this is not fully understood and needs further investigation.

Aged↗
PubMed2000

Psychosocial aspects of dental and general fears in dental phobic patients.

Phobic reactions can often be a significant health problem for fearful dental patients. This is true in particular for individuals with long-time avoidance and elevated general psychological distress. The aim of this study was to investigate the expression of dental fear among 67 dental phobic individuals with a low versus high degree of general fear. Reported etiologic background factors, avoidance time, general psychological distress and psychosocial manifestations and consequences of dental phobia were studied. No significant difference in dental anxiety level between individuals with low versus high general fear was found, and both groups reported high frequencies of negative dental experiences. The low-fear group reported a longer (though not statistically significant) average avoidance time than the high-fear group. However, patients with a high level of general fear showed a significantly higher degree of psychological distress, and also reported stronger negative social consequences from their dental anxiety. These results indicate that the character of dental fear might be different between different groups of fearful patients, which makes the condition psychologically handicapping. Such aspects should be assessed in the diagnostic analysis of patients with severe dental anxiety. In particular, assessments of signs of general psychological distress are warranted.

Activities of Daily Living↗
PubMed1997

The psychological status of U.S. Army soldiers during recent military operations.

This study compared general psychological symptoms measures on all Brief Symptom Inventory symptom dimensions and the Global Severity Index from samples of deployed and nondeployed U.S. Army soldiers. Psychological symptom measures were taken from samples of soldiers during deployment to operations in the Persian Gulf, Somalia, Kuwait, Haiti, and Bosnia. The purpose of this study was to determine whether deployment and gender had an effect on levels of symptom measures. Results indicated that soldiers who deployed to the Persian Gulf, Somalia, and Bosnia had significantly elevated measures of general psychological distress compared with nondeployed soldiers. Gender difference had little to no effect on reported symptom measures among deployed soldier samples. All female soldiers, whether deployed or not, had elevated measures of interpersonal sensitivity and somatization symptoms. Further research is warranted to address which factors, to include yet not be limited to mission, life events-related, and physical symptoms, may relate to why some deployments are more stressful than others on Army soldiers.

Adult↗